Provider Demographics
NPI:1669485256
Name:BROWN, SULETTE DOROTHEA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SULETTE
Middle Name:DOROTHEA
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-3517
Mailing Address - Country:US
Mailing Address - Phone:589-761-0627
Mailing Address - Fax:580-762-1066
Practice Address - Street 1:416 S LEWIS ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3517
Practice Address - Country:US
Practice Address - Phone:589-761-0627
Practice Address - Fax:580-762-1066
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK006863-00OtherMAGELLAN EAP